Healthcare Provider Details

I. General information

NPI: 1184696791
Provider Name (Legal Business Name): JOHN PAUL RAGONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FORT DIX BEHAVIORAL HEALTH SERVICES
FORT DIX NJ
08640
US

IV. Provider business mailing address

15 MILLMAN DR
EAST BRUNSWICK NJ
08816-5314
US

V. Phone/Fax

Practice location:
  • Phone: 609-562-3141
  • Fax: 609-562-4935
Mailing address:
  • Phone: 732-613-0963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA05747900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: